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Bill provides increases to NIH, cuts CDC and HRSA

On June 15, 2018, the House Appropriations Subcommittee on Labor, Health and Human Services, and Education marked up the FY 2019 funding bill. The legislation includes funding for programs within the Departments of Labor, Health and Human Services, and Education, and other related agencies, including the Social Security Administration.

The bill includes $177.1 billion in discretionary funding, essentially the same as the 2018 enacted level. Because funding for the bill was not increased over last year, increases were modest for some agencies and many agencies were flat-funded or cut.

The bill allocates increased funds for the National Institutes of Health (NIH) at $1.25 billion, for a total of $38.3 billion. These funds would boost numerous medical research programs and combat opioid abuse.

The bill provides increases for various NIH research initiatives, including:

$2.25 billion, a $401 million increase, for Alzheimer’s disease research

$400 million, a $100 million increase, for the Cancer Moonshot research initiative

$429 million, a $29 million increase, for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative

$437 million, a $147 million increase, for the All of Us (precision medicine) research initiative

$130 million, an increase of $30 million, for research to develop a universal influenza vaccine

$528 million, an increase of $15 million, for research on Combating Antibiotic-Resistant Bacteria

$366 million, an increase of $15 million, for Institutional Development Awards

$12.6 million for the Gabriella Miller “Kids First” pediatric cancer research initiative.

Because much of the increase to NIH is directed to special initiatives, many of the NIH institutes would receive only a 1.2 percent increase in FY 2019 if the funding levels in this bill prevail.

Centers for Disease Control and Prevention (CDC)– The legislation includes a total of $7.6 billion for CDC – $663 million below the FY 2018 enacted level and $2 billion above the President’s budget request. The decrease is due in part to the transfer of the Strategic National Stockpile to the HHS Office of the Assistant Secretary for Planning and Response (ASPR); when accounted for, the bill provides a programmatic increase of $427 million.This includes $848 million in transfers from the Prevention and Public Health Fund, which was established under the Affordable Care Act. The bill also continues the longstanding prohibition against using federal funds to advocate or promote gun control (without prohibiting research, per se—though no funds were included for it).

The bill includes $300 million to establish an Infectious Disease Rapid Response Reserve Fund to allow the Secretary of Health & Human Services to quickly respond to a pandemic, as well as funding for initiatives proposed in the President’s Budget to continue efforts to track children and families affected by the Zika virus and to address infectious disease in high-risk areas, especially those disproportionately affected by the opioid crisis.

Substance Abuse and Mental Health Services Administration (SAMHSA) – The bill funds SAMHSA at $5.6 billion, which is $448 million above the FY 2018 enacted level and $2.1 billion above the President’s request. The legislation maintains a prohibition on federal funds for the purchase of syringes or sterile needles but allows communities with rapid increases in cases of HIV and hepatitis to access federal funds for other activities, including substance-use counseling and treatment referrals.

The bill would reduce overall funding for the Health Resources Services Administration (HRSA), although some programs within the agency, including the Maternal and Child Health Block Grant, would receive slight increases. The Agency for Healthcare Research and Quality received $334 million in funding for FY 2019, the same level of funding as FY 2018. Notably, the agency was left as a stand-alone federal agency and not folded into NIH as a new institute, as proposed in the President’s Budgets for FY18 and FY19.

The legislation was approved in the Labor-HHS-Education Subcommittee along a party-line vote, with only Republicans voting to approve. Democrats voted no on the bill in part due to the flat funding, but also due to the presence of controversial riders, including a provision that would eliminate all Title X family planning funding and provisions that would stop the implementation of the Affordable Care Act (including prohibiting the use of any new discretionary funding to implement the program). Democrats also objected to the so-called Monsanto rider, which would block funding for the World Health Organization’s International Agency for Research on Cancer. That agency had released a report that concluded that a chemical in Monsanto’s products—including Roundup—was a possible carcinogen.

The full Appropriations Committee will mark up the bill the week of June 18, 2018.